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NUR247 - Maternal OB > MIDTERM: Prenatal Labs > Flashcards

MIDTERM: Prenatal Labs Flashcards

1
Q

It is determined that a clients blood Rh is negative and her partners is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time?

A) At 34 weeks gestation and immediately before discharge

B) 24 hours before delivery and 24 hours after delivery

C) In the first trimester and within 2 hours of delivery

D) At 28 weeks gestation and again within 72 hours after delivery

A

D) At 28 weeks gestation and again within 72 hours after delivery

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2
Q

What is the purpose of the ABO and antibody screen in pregnancy?

A. To determine blood glucose levels
B. To identify the mother’s blood type and screen for antibodies that may affect the baby
C. To check for anemia
D. To assess kidney function

A

B. To identify the mother’s blood type and screen for antibodies that may affect the baby

Rationale: The ABO and antibody screen is used to determine the mother’s blood type and screen for antibodies that may cause hemolytic disease of the fetus and newborn (HDFN).

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3
Q

What treatment is available if maternal antibodies against fetal red blood cells are identified?

A. Vitamin supplements
B. Immunoglobulin therapy
C. Rh immunoglobulin (RhIg) administration
D. Antihypertensive medications

A

C. Rh immunoglobulin (RhIg) administration

Rationale: If maternal antibodies against fetal red blood cells are identified, Rh immunoglobulin (RhIg) can be administered to prevent alloimmunization and hemolytic disease of the fetus and newborn.

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4
Q

What is the recommended treatment for an Rh-negative mother with an Rh-positive baby?

A. Rh immunoglobulin (RhIg) administration at 28 weeks and within 72 hours postpartum
B. Blood transfusion
C. Antibiotics
D. Bed rest

A

A. Rh immunoglobulin (RhIg) administration at 28 weeks and within 72 hours postpartum

Rationale: Rh immunoglobulin (RhIg) is administered to an Rh-negative mother at 28 weeks of gestation and within 72 hours postpartum if the baby is Rh-positive to prevent alloimmunization.

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5
Q

What is the treatment for a pregnant woman who tests positive for Hepatitis C?

A. Antiviral medications specific for Hepatitis C
B. Immediate delivery
C. Blood transfusion
D. Folic acid supplementation

A

A. Antiviral medications specific for Hepatitis C

Rationale: Antiviral medications specific for Hepatitis C can be used to manage the infection in a pregnant woman.

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6
Q

What is the recommended treatment for a pregnant woman with an active HSV infection at the time of delivery?

A. Antiviral therapy
B. Immediate delivery
C. Antibiotics
D. Bed rest

A

A. Antiviral therapy

Rationale: Antiviral therapy (e.g., acyclovir) is recommended to manage HSV infection, and cesarean delivery may be considered to prevent neonatal transmission.

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7
Q

What is the purpose of HBsAG screening in pregnancy?

A. To screen for HIV
B. To check for anemia
C. To assess thyroid function
D. To identify Hepatitis B infection in the mother

A

D. To identify Hepatitis B infection in the mother

Rationale: HBsAG screening is performed to identify Hepatitis B infection in the mother, which can be transmitted to the baby.

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8
Q

What is the purpose of the RPR or VDRL test in pregnancy?

A. To identify Hepatitis C infection
B. To screen for syphilis infection
C. To monitor blood glucose levels
D. To check for anemia

A

B. To screen for syphilis infection

Rationale: The RPR or VDRL test is performed to screen for syphilis infection in pregnancy.

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9
Q

What is the recommended treatment for a pregnant woman who tests positive for syphilis?

A. Antiviral medications
B. Penicillin therapy
C. Blood transfusion
D. Folic acid supplementation

A

B. Penicillin therapy

Rationale: Penicillin therapy is the recommended treatment for a pregnant woman who tests positive for syphilis.

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10
Q

What is the recommended action if a pregnant woman is found to be non-immune to rubella?

A. Immediate vaccination during pregnancy
B. Vaccination postpartum
C. Administration of antiviral medications
D. Immediate delivery

A

B. Vaccination postpartum

Rationale: If a pregnant woman is found to be non-immune to rubella, vaccination is recommended postpartum to protect future pregnancies.

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11
Q

What is the recommended treatment for a pregnant woman who tests positive for GBS colonization?

A. Immediate delivery
B. Blood transfusion
C. Folic acid supplementation
D. Administration of antibiotics during labor

A

D. Administration of antibiotics during labor

Rationale: Administration of antibiotics during labor (intrapartum prophylaxis) is recommended to prevent GBS transmission to the newborn.

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12
Q

Why is it important to screen for ABO and Rh incompatibility during pregnancy?

A. To prevent gestational diabetes
B. To prevent hemolytic disease of the fetus and newborn
C. To monitor thyroid function
D. To assess kidney function

A

B. To prevent hemolytic disease of the fetus and newborn

Rationale: Screening for ABO and Rh incompatibility is important to prevent hemolytic disease of the fetus and newborn (HDFN).

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13
Q

What laboratory tests are used to diagnose syphilis in pregnant women? (Select all that apply)

A. Rapid Plasma Reagin (RPR)
B. Venereal Disease Research Laboratory (VDRL)
C. Hepatitis B surface antigen (HBsAG)
D. Rubella immunity status

A

A. Rapid Plasma Reagin (RPR)
B. Venereal Disease Research Laboratory (VDRL)

Rationale: RPR and VDRL tests are used to diagnose syphilis in pregnant women.

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14
Q

What are the potential risks to the baby if a pregnant woman tests positive for Hepatitis C?

A. Preterm birth and low birth weight
B. Gestational diabetes and low birth weight
C. Hyperthyroidism and low birth weight
D. Increased risk of blood clots and low birth weight

A

A. Preterm birth and low birth weight

Rationale: A pregnant woman with Hepatitis C may have an increased risk of preterm birth and low birth weight for her baby.

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15
Q

Which lab test is used to screen for syphilis in pregnant women, and why is this screening important?

A. Hepatitis B surface antigen (HBsAG); to prevent liver disease

B. Rubella immunity status; to prevent rubella infection

C. Rapid Plasma Reagin (RPR); to prevent congenital syphilis

D. Blood glucose levels; to monitor for gestational diabetes

A

C. Rapid Plasma Reagin (RPR); to prevent congenital syphilis

Rationale: The Rapid Plasma Reagin (RPR) test is used to screen for syphilis in pregnant women, and this screening is important to prevent congenital syphilis.

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16
Q

A pregnant client at 32 weeks presents with a persistent headache, epigastric pain, and visual disturbances. Laboratory results reveal: AST 85 U/L, ALT 90 U/L, and platelets 90,000/mm³. What is the most likely condition?

A. Gestational diabetes
B. HELLP syndrome
C. Hyperemesis gravidarum
D. Placenta previa

A

B. HELLP syndrome

Rationale: Elevated liver enzymes (AST/ALT), low platelets (<100,000), and clinical symptoms suggest HELLP syndrome, a severe preeclampsia complication.

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17
Q

A client at 28 weeks has a uric acid level of 7 mg/dL. What should the nurse suspect?

A. Normal finding in pregnancy
B. Iron-deficiency anemia
C. Preeclampsia
D. Hyperthyroidism

A

C. Preeclampsia

Rationale: Elevated uric acid (>6 mg/dL) indicates impaired renal function, often seen in preeclampsia.

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18
Q

Which of the following is an abnormal WBC count for a pregnant client at 38 weeks?

A. 8,000/mm³
B. 12,000/mm³
C. 16,000/mm³
D. 25,000/mm³

A

D. 25,000/mm³

Rationale: WBC counts typically rise during pregnancy but should remain below 20,000/mm³. A value above this indicates infection or another complication.

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19
Q

A protein/creatinine ratio of 0.35 is noted in a pregnant client at 30 weeks. What should the nurse do next?

A. Document as normal
B. Reassess in 24 hours
C. Notify the provider
D. Initiate seizure precautions

A

C. Notify the provider

Rationale: A protein/creatinine ratio ≥0.3 indicates significant proteinuria and suggests preeclampsia.

20
Q

Which hemoglobin value is abnormal in a pregnant client at 36 weeks?

A. 10.8 g/dL
B. 11.2 g/dL
C. 9.5 g/dL
D. 12 g/dL

A

C. 9.5 g/dL

Rationale: Hemoglobin levels <11 g/dL in the second and third trimesters indicate anemia, requiring further evaluation.

21
Q

A postpartum client with preeclampsia has LDH of 700 U/L. What does this indicate?

A. Normal postpartum finding
B. Hemolysis
C. Impaired clotting
D. Hypovolemia

A

B. Hemolysis

Rationale: Elevated LDH (>600 U/L) suggests tissue breakdown or hemolysis, common in HELLP syndrome.

22
Q

Which platelet count is concerning for a client at 34 weeks gestation?

A. 160,000/mm³
B. 140,000/mm³
C. 90,000/mm³
D. 120,000/mm³

A

C. 90,000/mm³

Rationale: Platelet counts <100,000/mm³ are abnormal and suggest thrombocytopenia, often associated with preeclampsia or HELLP syndrome.

23
Q

A client at 28 weeks has serum creatinine of 1.3 mg/dL and proteinuria on urinalysis. What is the priority nursing action?

A. Recommend increased hydration
B. Monitor fetal movements
C. Encourage a low-protein diet
D. Notify the provider

A

D. Notify the provider

Rationale: Elevated creatinine (>1.1 mg/dL) and proteinuria suggest renal dysfunction, likely due to preeclampsia.

24
Q

Which condition is most likely in a pregnant client with AST 105 U/L, ALT 120 U/L, and severe right upper quadrant pain?

A. Acute fatty liver of pregnancy
B. Gestational hypertension
C. Preeclampsia without severe features
D. Chorioamnionitis

A

A. Acute fatty liver of pregnancy

Rationale: Extremely elevated liver enzymes and upper quadrant pain suggest liver dysfunction, indicative of acute fatty liver of pregnancy.

25
Q

A nurse assesses a client at 36 weeks with hemoglobin 10.2 g/dL and hematocrit 29%. Which intervention is most appropriate?

A. Reassure the client this is normal
B. Administer IV fluids
C. Recommend iron supplementation
D. Perform a blood transfusion

A

C. Recommend iron supplementation

Rationale: Hemoglobin <11 g/dL and hematocrit <33% indicate iron-deficiency anemia, commonly treated with iron supplements.

26
Q

What is the primary purpose of the ABO and antibody screen during pregnancy?

a) Detect anemia and thrombocytopenia
b) Identify maternal blood type and screen for antibodies that may harm the fetus
c) Monitor fetal hemoglobin levels
d) Determine the risk of preeclampsia

A

b) Identify maternal blood type and screen for antibodies that may harm the fetus

Rationale: The ABO and antibody screen identifies maternal blood type and detects antibodies that could lead to hemolytic disease of the fetus or newborn (HDFN).

27
Q

When should RhoGAM be administered to an Rh-negative mother? (Select all that apply)

a) At 12 weeks gestation
b) At 28 weeks gestation
c) Within 72 hours postpartum if the infant is Rh-positive
d) If an antibody screen detects alloimmunization
e) After any invasive procedure like amniocentesis

A

b) At 28 weeks gestation
c) Within 72 hours postpartum if the infant is Rh-positive
e) After any invasive procedure like amniocentesis

Rationale: RhoGAM is administered to Rh-negative mothers at 28 weeks, postpartum if the infant is Rh-positive, and after invasive procedures to prevent alloimmunization.

28
Q

What is the recommended treatment for a pregnant woman with a positive HBsAg?

a) Antiviral therapy during pregnancy

b) Administer hepatitis B immunoglobulin (HBIG) to the mother

c) Administer HBIG and the hepatitis B vaccine to the newborn within 12 hours of birth

d) Perform an emergency cesarean delivery

A

c) Administer HBIG and the hepatitis B vaccine to the newborn within 12 hours of birth

Rationale: Newborns of mothers with a positive HBsAg should receive HBIG and the hepatitis B vaccine within 12 hours of birth to reduce the risk of vertical transmission.

29
Q

Which laboratory finding is suggestive of HELLP syndrome in a pregnant woman?

a) Elevated ALT and AST levels
b) Low hemoglobin and hematocrit levels
c) Elevated uric acid levels
d) Platelet count >150,000/mm³

A

b) Low hemoglobin and hematocrit levels

Rationale: Elevated liver enzymes such as ALT and AST are hallmark findings in HELLP syndrome, indicating liver damage.

30
Q

What does a protein/creatinine ratio of ≥0.3 mg/dL in pregnancy indicate?

a) Normal renal function
b) Proteinuria, a sign of preeclampsia
c) Gestational diabetes
d) Chronic hypertension

A

b) Proteinuria, a sign of preeclampsia

Rationale: A protein/creatinine ratio of ≥0.3 mg/dL indicates proteinuria, a key diagnostic criterion for preeclampsia.

31
Q

What is the appropriate management for a pregnant patient with a reactive RPR test?

a) Administer acyclovir prophylactically
b) Treat with penicillin G to prevent congenital syphilis
c) Monitor with serial ultrasounds for fetal growth restriction
d) Administer hepatitis B vaccine

A

b) Treat with penicillin G to prevent congenital syphilis

Rationale: Penicillin G is the treatment of choice for syphilis to prevent vertical transmission and congenital syphilis.

32
Q

Which lab abnormality requires immediate intervention to reduce the risk of preterm labor?

a) Low platelet count
b) Elevated uric acid levels
c) Positive Group B Streptococcus (GBS) culture
d) Elevated WBC count >15,000/mm³

A

c) Positive Group B Streptococcus (GBS) culture

Rationale: Positive GBS culture requires intrapartum prophylaxis with antibiotics to prevent neonatal GBS infection, a significant cause of preterm labor.

33
Q

Which finding on a rubella screening test indicates immunity?

a) Positive IgG antibodies
b) Positive IgM antibodies
c) Negative IgG antibodies
d) Negative IgM antibodies

A

a) Positive IgG antibodies

Rationale: Positive IgG antibodies indicate immunity to rubella, protecting the mother and fetus from infection during pregnancy.

34
Q

What intervention is recommended for a pregnant patient with non-immune rubella status?

a) Administer the MMR vaccine during pregnancy

b) Administer the MMR vaccine postpartum and advise avoiding conception for 1 month

c) Administer rubella immunoglobulin immediately

d) Monitor for fetal growth restriction

A

b) Administer the MMR vaccine postpartum and advise avoiding conception for 1 month

Rationale: The live MMR vaccine is contraindicated during pregnancy but should be given postpartum to prevent future rubella infections.

35
Q

What is the clinical significance of elevated uric acid levels during pregnancy?

a) Indicates risk of gestational diabetes
b) Suggests preeclampsia development
c) Reflects maternal dehydration
d) Suggests placental abruption

A

b) Suggests preeclampsia development

Rationale: Elevated uric acid levels are often associated with preeclampsia due to reduced renal clearance and placental dysfunction.

36
Q

Which platelet count in pregnancy is indicative of thrombocytopenia?

a) <200,000/mm³
b) <100,000/mm³
c) <150,000/mm³
d) <300,000/mm³

A

b) <100,000/mm³

Rationale: A platelet count below 100,000/mm³ may indicate thrombocytopenia, which is concerning in conditions such as HELLP syndrome.

37
Q

What is the treatment for a pregnant woman with elevated ALT and AST levels indicative of HELLP syndrome?

a) Administer magnesium sulfate
b) Immediate delivery of the fetus
c) Initiate antihypertensive therapy
d) Start corticosteroid therapy

A

b) Immediate delivery of the fetus

Rationale: Delivery is the definitive treatment for HELLP syndrome to prevent further maternal and fetal complications.

38
Q

What is the first-line antibiotic for intrapartum GBS prophylaxis?

a) Cefazolin
b) Erythromycin
c) Penicillin
d) Vancomycin

A

c) Penicillin

Rationale: Penicillin is the first-line antibiotic for GBS prophylaxis to reduce neonatal GBS infection.

39
Q

What is the recommended treatment for a pregnant woman with WBC >15,000/mm³ and fever?

a) Monitor for labor progression
b) Administer broad-spectrum antibiotics for suspected infection
c) Perform an immediate cesarean section
d) Reduce activity and hydrate

A

b) Administer broad-spectrum antibiotics for suspected infection

Rationale: Elevated WBC count and fever suggest infection, requiring prompt antibiotic therapy to prevent maternal and fetal complications.

40
Q

What is the significance of an elevated protein/creatinine ratio in a pregnant patient?

a) It suggests placental abruption.
b) It is diagnostic of preeclampsia.
c) It confirms gestational diabetes.
d) It indicates HELLP syndrome.

A

b) It is diagnostic of preeclampsia.

Rationale: A protein/creatinine ratio of ≥0.3 mg/dL is diagnostic of proteinuria, a key component of preeclampsia diagnosis.

41
Q

What is the primary goal of monitoring liver function tests (AST/ALT) during pregnancy?

a) To screen for gestational diabetes
b) To assess for potential liver damage in conditions like HELLP syndrome
c) To monitor fetal liver function
d) To evaluate renal clearance

A

b) To assess for potential liver damage in conditions like HELLP syndrome

Rationale: Elevated AST and ALT levels may indicate liver involvement in HELLP syndrome or other pregnancy complications.

42
Q

What is the appropriate follow-up for a pregnant patient with non-immune rubella status?

a) Monthly fetal growth ultrasounds
b) Administer rubella vaccine during pregnancy
c) Postpartum vaccination with MMR
d) Weekly NSTs starting at 28 weeks

A

c) Postpartum vaccination with MMR

Rationale: Non-immune rubella patients should receive the MMR vaccine postpartum, as it is contraindicated during pregnancy.

43
Q

Which finding on a urinalysis in pregnancy warrants further investigation?

a) Trace protein
b) Glucose 1+
c) Proteinuria ≥0.3 mg/dL
d) Ketones negative

A

c) Proteinuria ≥0.3 mg/dL

Rationale: Proteinuria ≥0.3 mg/dL is indicative of preeclampsia and warrants additional evaluation and monitoring.

44
Q

What is the recommended intervention for a newborn born to a hepatitis B-positive mother?

a) Administer HBIG and hepatitis B vaccine within 12 hours of birth
b) Perform a hepatitis C test immediately
c) Delay breastfeeding for 24 hours
d) Administer only HBIG within 12 hours

A

a) Administer HBIG and hepatitis B vaccine within 12 hours of birth

Rationale: The combination of HBIG and hepatitis B vaccine reduces vertical transmission of hepatitis B to the newborn.

45
Q

What is the most likely cause of an elevated WBC count (>15,000/mm³) in a pregnant patient with no signs of infection?

a) Normal physiological change of pregnancy
b) Chronic hypertension
c) HELLP syndrome
d) Gestational diabetes

A

a) Normal physiological change of pregnancy

Rationale: A mild elevation in WBC count is a normal physiological response during pregnancy due to increased immune activity.

NUR247 - Maternal OB (16 decks)

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